This application addresses broad Challenge Area (05) Comparative Effectiveness Research, and specific Topic (05-DE-102) Treatment of tobacco and drug dependence in dental settings. The goal of this project is to develop an Internet/Intranet-based Motivational Enhancement Therapy (iMET) program for adolescents that targets tobacco, alcohol, and drug use. These substances are associated with the leading causes of death during adolescence and serious health problems later in life. Our investigative team has previously developed screening, brief intervention, and referral to treatment (SBIRT) strategies for medical offices that target alcohol and drug use. We created a computer program (cSBIRT) based on the CRAFFT screen, which adolescent patients could self-administer in the waiting room before seeing the primary care provider (PCP). The program immediately shows the adolescent his/her score and level of risk, presents scientific information and true life stories about the harmful effects of substance use, and prints a Report sheet that prompts the PCP to advise the teen to stay away from alcohol and drugs. We found in a recent study that 40% of adolescent patients who received cSBIRT stopped using alcohol/drugs, which was significantly better than Treatment As Usual (TAU). However, 60% did not stop and need additional counseling, such as MET. We created our MET intervention to be specifically suited to the unique developmental needs of adolescents. We found in another recent study that MET was significantly better than TAU in reducing drug use among teens in an outpatient substance abuse treatment population. We will now adapt this proven MET intervention and test it in a primary care population of adolescents coming for routine medical and dental care, where we believe it will have an even greater effect. First, we must adapt MET so that it targets tobacco use in addition to other substances, and convert its tools to a computerized format. We will design the iMET program so that adolescents can self- administer nearly all of it, which makes it practical for use in busy PCP offices. We also will add a new feature, Technological Extenders (TEs), which are computer-generated personalized emails/text messages that PCPs send to teen patients during the months after the office visit to extend the effects of the iMET over time. We will hold focused group discussions with teens, parents, and PCPs during the first year of the project, and design the iMET system to respond to their opinions and needs. We will add dental practices to our research network of nine PCP offices, and then conduct a small pilot study comparing iMET/TE with TAU. The purpose of the pilot is to estimate the effect size of the new iMET/TE system in reducing tobacco, drug, and alcohol use. We will use these estimates and our pilot study experience to design a future study comparing iMET/TE to TAU in a much larger population of adolescents, which could prove with statistical certainty that the iMET/TE system is effective. The purpose of this project is to improve adolescent behavioral counseling services in healthcare settings with a new Internet/Intranet-based Motivational Enhancement Therapy (iMET) intervention that targets the use of tobacco, alcohol, and other drugs. If proven effective, we will disseminate iMET to primary care dental and medical offices across the U.S. Early intervention can substantially reduce teen substance use and its related mortality;prevent other serious consequences;and greatly decrease the associated later burdens of human suffering and high treatment costs.